Endoscopic treatment of bronchial complications after lung transplantation

Gasanov A.M.; Khubutiya M.Sh.; Tarabrin E.A.; Danielyan Sh.N.; Kallagov T.E.; Ibavov I.U.; Kotandzhyan V.G.

doi:https://doi.org/10.17116/hirurgia202109112

Gasanov A.M.

Sklifosovsky Research Institute for Emergency Medicine

Khubutiya M.Sh.

Sklifosovsky Research Institute for Emergency Care

ORCID: 0000-0002-0746-1884

Tarabrin E.A.

Sklifosovsky Research Institute for Emergency Medicine

Danielyan Sh.N.

Sklifosovsky Research Institute for Emergency Medicine

Kallagov T.E.

Sklifosovsky Research Institute for Emergency Care

Ibavov I.U.

Sklifosovsky Research Institute for Emergency Care

ORCID: 0000-0001-5989-5505

Kotandzhyan V.G.

Sklifosovsky Research Institute for Emergency Care

Endoscopic treatment of bronchial complications after lung transplantation

Authors:

Gasanov A.M., Khubutiya M.Sh., Tarabrin E.A., Danielyan Sh.N., Kallagov T.E., Ibavov I.U., Kotandzhyan V.G.

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Journal: Pirogov Russian Journal of Surgery. 2021;(9): 12‑18

DOI: 10.17116/hirurgia202109112

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To cite this article:

Gasanov AM, Khubutiya MSh, Tarabrin EA, Danielyan ShN, Kallagov TE, Ibavov IU, Kotandzhyan VG. Endoscopic treatment of bronchial complications after lung transplantation. Pirogov Russian Journal of Surgery. 2021;(9):12‑18. (In Russ.)
https://doi.org/10.17116/hirurgia202109112

Подписка 2026 Хирургия. Журнал им. Н.И. Пирогова (Pirogov Russian Journal of Surgery)

Использование инфографики авторами научных работ

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OBJECTIVE

To analyze the incidence and structure of bronchial complications following lung transplantation and evaluate an effectiveness of endoscopic treatment of these events.

MATERIAL AND METHODS

The study enrolled 50 patients after bilateral lung transplantation (24 men and 26 women). Mean age of patients was 35.4±5 (19; 61) years. Ischemia of bronchial mucous membrane of the transplant was intraoperatively and postoperatively analyzed. We also assessed severity and prevalence of anastomotic and non-anastomotic cicatricial bronchial stenoses.

RESULTS

All patients after lung transplantation were diagnosed with bronchial complications, i.e. ischemia of bronchial mucous membrane of the transplant. In 76% of patients, these complications did not require endoscopic treatment. Surgical and endoscopic treatment was required in 24% of cases. Three patients (6%) underwent intraoperative correction of bronchial anastomosis. Bronchial suture failure was diagnosed in 3 patients (6%), cicatricial bronchial stenosis — in 6 (12%) cases. Endoscopic stenting was effective for recovery of bronchial patency with complete epithelialization of mucous membrane. Stenting of lobar bronchus with application of mitomycin C was effective in patients with non-anastomotic stenoses type III after lung transplantation.

CONCLUSION

Major bronchial complications occurred in 24% of patients after lung transplantation. Endoscopic treatment of bronchial complications using a self-fixing silicone endoprosthesis after lung transplantation was effective in all patients with anastomotic and non-anastomotic cicatricial strictures. Mitomycin C prevented excessive growth of granulation and scar tissue.

Keywords:

lung transplantation

bronchial complications

bronchial stenosis

Authors:

Gasanov A.M.

Sklifosovsky Research Institute for Emergency Medicine

Khubutiya M.Sh.

Sklifosovsky Research Institute for Emergency Care

ORCID: 0000-0002-0746-1884

Tarabrin E.A.

Sklifosovsky Research Institute for Emergency Medicine

Danielyan Sh.N.

Sklifosovsky Research Institute for Emergency Medicine

Kallagov T.E.

Sklifosovsky Research Institute for Emergency Care

Ibavov I.U.

Sklifosovsky Research Institute for Emergency Care

ORCID: 0000-0001-5989-5505

Kotandzhyan V.G.

Sklifosovsky Research Institute for Emergency Care

Received:

12.08.2020

Accepted:

21.04.2021

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References:

Chambers DC, Cherikh WS, Harhay MO, Hayes D Jr, Hsich E, Khush KK, Meiser B, Potena L, Rossano JW, Toll AE, Singh TP, Sadavarte A, Zuckermann A, Stehlik J, International Society for Heart and Lung Transplantation. The International Thoracic Organ Transplant Registry of the International Society for Heart and Lung Transplantation: Thirty-sixth adult lung and heart — lung transplantation Report — 2019; Focus theme: Donor and recipient size match. J Heart Lung Transplant. 2019;38(10):1015-1066. https://doi.org/10.1016/j.healun.2019.08.001
Chambers DC, Yusen RD, Cherikh WS, Goldfarb SB, Kucheryavaya AY, Khusch K, Levvey BJ, Lund LH, Meiser B, Rossano JW, Stehlik J; International Society for Heart and Lung Transplantation. The Registry of the International Society for Heart and Lung Transplantation: Thirty-fourth Adult Lung and Heart-Lung Transplantation Report-2017; Focus Theme: Allograft ischemic time. J Heart Lung Transplant. 2017;36(10):1047-1059. https://doi.org/10.1016/j.healun.2017.07.016
Santacruz JF, Mehta AC. Airway complications and management after lung transplantation: ischemia, dehiscence, and stenosis. Proc Am Thorac Soc. 2009;6(1):79-93. https://doi.org/10.1513/pats.200808-094GO
Chhajed PN, Malouf MA, Tamm M, Spratt P, Glanville AR. Interventional bronchoscopy for the management of airway complications following lung transplantation. Chest. 2001;120(6):1894-1899. https://doi.org/10.1378/chest.120.6.1894
Moreno P, Alvarez A, Algar FJ, Cano JR, Espinosa D, Cerezo F, Baamonde C, Salvatierra A. Incidence, management and clinical outcomes of patients with airway complications following lung transplantation. Eur J Cardiothorac Surg. 2008;34(6):1198-1205. https://doi.org/10.1016/j.ejcts.2008.08.006
Thistlethwaite P, Yung G, Kemp A, Osbourne S, Jamieson SW, Channick C, Harrell J. Airway stenoses after lung transplantation: Incidence, management, and outcome. J Thorac Cardiovasc Surg. 2008;136(6):1569-1575. https://doi.org/10.1016/j.jtcvs.2008.08.021
De Gracia J, Culebras M, Alvarez A, Catalán E, De la Rosa D, Maestre J, Canela M, Román A. Bronchoscopic balloon dilatation in the management of bronchial stenosis following lung transplantation. Respir Med. 2007;101(1):27-33. https://doi.org/10.1016/j.rmed.2006.04.019
Weder W, Inci I, Korom S, Kestenholz PB, Hillinger S, Eich C, Irani S, Lardinois D. Airway complications after lung transplantation: risk factors, prevention and outcome. Eur J Cardiothorac Surg. 2009;35(2):293-298. https://doi.org/10.1016/j.ejcts.2008.09.035
Spector JE, Werkhaven JA, Spector NC, Huang S, Page RN, Baranowski B, Luther M, McGehee B, Reinisch L. Preservation of Function and Histologic Appearance in the Injured Glottis With Topical mitomycin-C. Laryngoscope. 1999;109(7 Pt 1):1125-1129. https://doi.org/10.1097/00005537-199907000-00022
Madden BP, Kumar P, Sayer R, Murday A. Successful resection of obstructing airway granulation tissue following lung transplantation using endobronchial laser (Nd:YAG) therapy. Eur J Cardiothorac Surg. 1997;12(3):480-485. https://doi.org/10.1016/s1010-7940(97)00207-8
Mohan A, Guleria R, Mohan C, Sharma R. Laser bronchoscopy— current status. J Assoc Physicians India. 2004;52:915-920.
Colt H, Murgu S. Rigid Bronchoscopy with Laser and Stent Placement for Bronchus Intermedius Obstruction from Lung Cancer Involving the Right Main Pulmonary Artery. In: Colt H, Murgu S. Bronchoscopy and Central Airway Disorders: A Patient-Centered Approach. Saunders; 2012:269-278.
Keller CA, Hinerman R, Singh A, Alvarez F. The use of endoscopic argon plasma coagulation in airway complications after solid organ transplantation. Chest. 2001;119(6):1968-1975. https://doi.org/10.1378/chest.119.6.1968
Lari SM, Gonin F, Colchen A. The management of bronchus intermedius complications after lung transplantation: A retrospective study. J Cardiothorac Surg. 2012;7:8. https://doi.org/10.1186/1749-8090-7-8